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# DLA Official Forms

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| Form Number:  DLA7018                                                                                                                                                                                                                                                             |
|-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
| Form Title:  DLA Supervisor Industrial Self Safety Inspection Checklist                                                                                                                                                                                                           |
| Form Version:  Jun 2018                                                                                                                                                                                                                                                           |
| Status:  Active                                                                                                                                                                                                                                                                   |
| Functional Area:  Chief of Staff                                                                                                                                                                                                                                                  |
| Opr:  CoS                                                                                                                                                                                                                                                                         |
| Safeguards:  none                                                                                                                                                                                                                                                                 |
| Electronic:  Yes                                                                                                                                                                                                                                                                  |
| Form Link:  Documents/FormsSite/forms/DL7018.pdf                                                                                                                                                                                                                                  |
| Type:  Primary                                                                                                                                                                                                                                                                    |
| Prescribed:  DLAI 6055.01                                                                                                                                                                                                                                                         |
| Description:  To provide a consistent approach for supervisors to verify required safety information is posted and to assist in identifying workplace hazards when conducting self safety inspections in industrial areas across the Agency. For use by the workplace supervisor. |
| Records Retention:  6000.3 Safety and Health Case Files. Destroy 5 years after all aspects of the case are closed.                                                                                                                                                                |
| Form Audience:                                                                                                                                                                                                                                                                    |

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